Free SC004 - California

PARTY NAME AND ADDRESS

Plaintiff/Defendant

SUPERIOR COURT OF SAN LUIS OBISPO COUNTY SMALL CLAIMS DIVISION San Luis Obispo Branch, 1035 Palm Street, Rm 385, San Luis Obispo, CA 93408 Grover Beach Branch, 214 South 16th Street, Grover Beach, CA 93433 Paso Robles Branch, 549 10th Street, Paso Robles, CA 93446
Plaintiff:

Defendant:

DECLARATION OF DEFAULT IN PAYMENTS AND REQUEST FOR COURT HEARING (SMALL CLAIMS)

CASE NO:

I, ___________________________________ declare as follows:
DECLARANT NAME

I am the plaintiff/defendant in the within action. A Mediation Agreement was entered into on __________________, whereby plaintiff/defendant _____________________________ was to make payments of $___________ per month, commencing _______________________, and said Plaintiff/defendant has defaulted in making payments. To date I have received $________________on my claim.

I am hereby requesting that the court set this matter on its earliest calendar for entry of judgment.

On __________________________, I mailed (by regular U.S. mail) a copy of this Declaration and Request for Hearing to plaintiff/defendant, at:
STREET ADDRESS

CITY

STATE

ZIP

I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct.
DATE SIGNATURE OF DECLARANT

SC004 Rev. 10/22/03 Optional

DECLARATION OF DEFAULT IN PAYMENTS AND REQUEST FOR COURT HEARING(SMALL CLAIMS)

CCP 116.620